The Outbreak of AIDS in Brazil - Essay Example

AIDS IN BRAZIL RENE DAVILA ENGLISH 302 RON HESS APRIL 17, 2008 AIDS IN BRAZIL The Outbreak of AIDS in Brazil During the 1990'sand How it Got Under Control in 2005-2006 The first case of AIDS in Brazil was recorded back in 1982. (Avert.Org, 2008). Around that time, the country was struggling to get rid of its last military dictatorship and establishing democracy through the efforts of civil society and non-government organizations (NGOs). These civil society groups urged the new democratic government to act quickly and not to ignore the dangers of the AIDS epidemic. So those organizations "encouraged a climate of social solidarity, allowing open and frank debate about HIV and AIDS" (Avert.Org, 2008). At this time, a group of health professionals emerged that was determined to re-model the public health system. Thus they started what it is known as the "health reform movement" in Brazil (Camargo, 2005). In 1982, there were held democratic elections for state governor after many years of military regimes. The opposition triumphed in some key states and members of the "health reform movement" were employed in the State Health Secretariats. Camargo states that through this new order "the movement towards integrated health policies thus began to gain ground, eventually resulting in the formation of the Unified Health Service - the SUS" (2005). In 1983, the first diagnoses of AIDS were made in Brazil. By that time the first official program against this disease was established in So Paulo. Eventually this initiative led to the creation of the National STD and AIDS Department (Sexually-Transmitted Disease -STD-) in 1985 when democracy was restored (Camargo, 2005; Avert.Org, 2008). In this year the first NGOs against AIDS began to be founded, such as the GAPA (Support Group for AIDS Prevention), the ABIA (the Brazilian Interdisciplinary Association for AIDS), Grupo Pela Vidda ("Group for Life") (founded in 1989), among many others (Avert.Org, 2008). According to Avert.Org (2008) "by this time, the rate of new HIV infections was rapidly increasing." Camargo states the following: "The number of AIDS-related deaths began to increase and the National STD/AIDS Programme was created in 1986 - in the first full year that the Presidency of the Republic was occupied by a civilian since the military coup in 1964. Also in 1986 the VIII National Health Conference accepted the ideas of the health reform movement, which eventually influenced the health-relevant sections of the new Federal Constitution promulgated in 1988 (a watershed in Brazil's re-democratization). The Unified Health System (SUS) was thus born." (Camargo, 2005). The new Constitution had a heavy focus on human rights so this fact helped a lot in the fight against HIV/AIDS in Brazil (Avert.Org, 2008). Official prevention campaigns started in 1987. Camargo asserts the following about this period: "the idea began to be accepted that prevention involved battling prejudice and discrimination and promoting solidarity and the rights of people living with HIV and AIDS" (2005). According to Avert.Org the situation was not improving at the beginning of the 1990s. Avert.Org (2008) remarks that "not everyone was happy with the way that the government was handling the epidemic." Herbert Daniel, an HIV positive activist, published a book denouncing the failure of Brazil's government to handle successfully the negative effects of the HIV/AIDS epidemic (Avert.Org, 2008). At the beginning of that decade, the World Bank predicted that by the year of 2000 there would be 1.2 million people infected with HIV in Brazil (IAS, 2005; Okie, 2006; Avert.Org, 2008). Thanks to the agressive prevention and treatment programs implemented in this country, the actual figure was around 600,000 people living with HIV in Brazil (Avert.Org, 2008). The turning point can be found in the second half of the 1990s. Camargo states it as follows: "World Bank financing for projects in the health area completely changed the international scenario. With the signing of the first Agreement between Brazil and the World Bank in 1994, the National STD/AIDS Programme truly began to flourish" ( 2005). In 1996, the Brazilian government stepped forward by assuming new health policies: "When trials in 1996 showed that HAART - a form of treatment involving combinations of antiretroviral drugs (ARV) - had significant benefits to the health of people living with HIV, activist groups in Brazil put pressure on the government to act upon this pledge. In July 1996, the Brazilian Minister of Health announced that ARVs would be provided for free to all people living with HIV that required them" (Avert.Org, 2008). The policy of universal and free access to medications had a very strong impact in the fight against HIV/AIDS in Brazil after 1996. It is important to say that the World Bank recommended to the Brazilian government not to undertake that policy. Regarding the benefits of that innovative policy, Camargo states that: "Over the years, this strategy has been regarded not only as effective from the viewpoint of mortality reduction but has also saved the government money on expenditure on AIDS treatment in the initial stages of the disease and has proved to be much cheaper than financing repeated hospital admissions by seriously ill patients" (2005). Avert.Org remarks that since 2000 the number of people living with HIV in Brazil has stabilized around 600,000, and at the same time the AIDS incidence has increased, possible due to the delayed effect of infections in previous years. But the AIDS mortality rate has significantly decreased since the new policies of free and universal treatment have been introduced (Avert.Org, 2008). Camargo explains it in the following terms: "The beginning of the new century marks the recognition of the Brazilian HIV/AIDS programme as an international beacon. Its most significant feature continues to be the indivisible link that has been established between 'prevention and care'. The incorporation of civil rights in the context of prevention, universal access, etc, reflectS (i) the fundamental legal principles enshrined in the Unified Health System and (ii) the dynamic evolution of a society responding to the challenge represented by a major global epidemic." (2005). In Brazil, the epidemic first affected men who have sex with men (MSM) and injecting drug users (IDUs). But lately the cases of heterosexual transmission have grown out of proportion and women have been affected increasingly (IAS, 2005). Undoubtedly, this country has been quite successful dealing with the HIV/AIDS epidemic. Colitt states it as follows: "Brazil's AIDS infection rates climbed exponentially until the early 1990s when international health authorities warned the epidemic could grow out of control. () Today the World Health Organization considers Brazil's AIDS strategy -- which includes large-scale distribution of free condoms, free and fast testing of the HIV virus, and free antiretroviral drugs for all patients -- a model for developing nations." (2007). Harvard School of Public Health describes Brazil's success as "remarkable" (Duffy, 2007). Okie (2006) remarks that Brazil's model has been "hailed internationally as a milestone in the fight against AIDS" (see also USAID, 2004). Avert.Org points out that the reason behind this "impressive" success has been the government's reaction to the epidemic as well as "the involvement of civil groups and people living with HIV" as "the most outstanding feature". UNAIDS agrees with that assertion explaining Brazil's success story as follows: "Brazil's response to AIDS has benefited from consistently strong political support from the highest level of government, which has led to regulatory policies as well as a very clear and permanent allocation of financial resources at national, state and local levels. () The strong partnership with civil society has been crucial to the HIV response in this country." (UNAIDS, 2007), Gewertz remarks the following when assessing Brazil's response to the epidemic: "people living with AIDS receive far more effective, compassionate, and consistent care in Brazil than in almost any other country in the developing world" (Gewertz, 2007). The key to Brazil's success has been its emphasis on prevention and treatment. Mantesso remarks the following about the treatment efforts in Brazil: "Brazil's national AIDS treatment program is one of the world's most effective, reflecting a combination of compassion, medical foresight and economic intelligence" (2006). Okie explains Brazil's success as follows: "Indeed, Brazil's emphasis on prevention as well as treatment has helped to keep its epidemic relatively contained and stable, providing a model for the expansion of treatment programs elsewhere" (2006). IAS emphasizes the role that NGOs have played in the fight against HIV/AIDS in Brazil: "Nongovernmental organizations (NGOs) play a central role in Brazil's national response to AIDS, working in partnership with the public sector to provide services and programs to reduce stigma, educate the public, and provide care and support for people living with HIV/AIDS. NGOs in Brazil are also active in advocacy to promote the human rights of people living with HIV/AIDS, inform the development of government policies and strengthen HIV research" (2005). For Jim Yong Kim, former director of the World Health Organizations's Department of HIV/AIDS and a professor at Harvard Medical School in Boston, Brazil is the "only example we have where there's universal access" to antiretroviral drugs in the developing countries. He explains Brazil's success as follows: "I think what they did was to say, We're going to scale up treatment, but we're going to scale up prevention along with it, because it doesn't make sense to do one without the other.'" (Okie, 2006). Okie asserts that "prevention efforts in Brazil targeting high-risk populations have achieved some impressive success, particularly among injection-drug users and commercial sex workers" (2006). Okie gives an account of the key features of Brazil's model as follows: "The establishment of Brazil's treatment program fundamentally changed the national response to the AIDS epidemic. Back in 1996, when international studies showed that three-drug antiretroviral therapy improved survival and quality of life, Brazil's Congress enacted the law providing free treatment to people with AIDS. Between 1997 and 2005, the government spent a total of $3.5 billion in response to HIV and AIDS, including $2 billion for antiretroviral drugs" (2006). But the outstanding succes of Brazil has been faced with a lot of controversy. Avert.Org states the following about the main feature of Brazil's success, which is the reason behind the disputes surrounding the agressive initiatives undertaken by Brazil: "A major factor in Brazil's success has been its ability to produce several AIDS drugs locally. Brazil has a large pharmaceutical industry and around 40% of ARVs currently purchased by the government are manufactured domestically. Since 1996 Brazil has complied with the international TRIPS agreement, which was established to protect the patent rights of pharmaceutical companies. This agreement limits the genetic production of drugs that have already been patented in another country. Several ARVs that are produced generically in Brazil were patented before the TRIPS agreement, which means that they can legally be copied" (2008). Brazil is in the need of getting most of the ARVs internationally. The government has put a strong pressure on pharmaceutical companies trying to lower their prices. Avert.Org continues explaining the root of the controversy in the following terms: "A major tool in these negotiations has been a clause in the TRIPS agreement that allows developing countries to issue 'compulsory licenses' for drugs. Compulsory licenses allow countries to override patent laws and produce their own generic (copied) versions of company-owned drugs, and can be issued when the government of a developing country deems it to be a public health emergency" (2008). Avert.Org explains the decision of Brazil's government to issue compulsory licenses as follows: "In May 2007 however, the Brazilian President Luiz Inacio Lula da Silva announced that Brazil would be issuing a compulsory license to produce a lower cost version of the ARV efavirenz, patented by the company Merck" (2008). Another point of debate related to the massive distribution of condoms as a prevention method is assessed by Avert.Org: "When working with developing countries, the U.S. government generally encourages them to adopt an 'ABC' approach to HIV prevention, which promotes abstinence and being faithful to one partner as well as condom use. Although Brazil does incorporate these other messages into its prevention schemes, it has placed a heavy emphasis on condom use and refused to stick to an ABC approach. This has been a source of conflict with U.S. officials" (2008). But the controversy doen's stop here as Avert.Org asserts it: "On top of this, the Brazilian government's focus on preventing HIV amongst sex workers has clashed with the U.S. policy of refusing aid to any HIV and AIDS prevention schemes that do not explicitly oppose the sex trade. In 2005, the Brazilian government refused the US government's offer of $40 million funding for HIV and AIDS programs, as it would have required them to state that they are against the practice of commercial sex work." (2008). Bate and Tren point out the root of the controversial measures taken by Brazil as follows: "Although Brazil's AIDS treatment program has recorded many notable successes, the aggressive stance that the country has taken in threatening drug patents and forcing down drug prices could weaken incentives for long-run development of new drugs. The government of Brazil has abused the spirit of international agreements such as the Doha Declaration to secure lower drug prices, even though these agreements were intended to secure lower prices for the poorest nations dealing with health problems like HIV/AIDS." (2005) Another source of debate can be found with the prevention measures related to the use of condom, which goes against Catholic Church principles: "The percentage of Brazil's sexually active youth using condoms rose to 60 percent in 2005, from only 10 percent two decades ago. () Brazil's Catholic church has harshly criticized the government's distribution of condoms in high schools and during the famously unchaste Carnival celebrations" (Colitt, 2007). Currently, the HIV/AIDS epidemic in Brazil can be considered to be stable. The Brazilian Ministry of Health sums up its achievements as follows: "As at December 2006 there had been 190 thousand AIDS-related deaths in Brazil. In 1995 the mortality curve accompanied the AIDS incidente curve, reaching the rate of 9.7 deaths per 100 thousand inhabitants. Following the introduction of the policy of universal access to antiretroviral treatment, there has been a significant fall in mortality. Despite the mortality rate having gone down in Brazil as a whole and in the south-east and midwest regions, it has increased in the remaining three regions." (2008). The Economist (2008) states that the epidemic has spread across Brazil providing "a portrait in red" of the country. On a recent UNGASS report announced by the National STD and AIDS Programme the current situation in Brazil is explained: "The Brazilian Ministry of Health releases this Thursday, 14/02, its report entitled "UNGASS: the Brazilian Response to the AIDS Epidemic", which provides a picture of the situation of the disease in Brazil. The document shows that although antiretroviral drugs are available through the National Health System (NHS), treatment nevertheless begins late and not all patients are being benefited. The report also indicates positive results with regard to financial resources, the impact of the compulsory licensing of the antiretroviral drug Efavirenz and the monitoring of the epidemic." (National STD and AIDS Programme, 2008). On a global basis, analysing the impact of HIV/ADIS around the world, UNAIDS published an update that reveals the following facts about the pandemic: "Number of people living with HIV in 2007: Total: 33.2 million (30.6-36.1 million). "People newly infected with HIV in 2007: Total: 2.5 million (1.8-4.1 million). "AIDS deaths in 2007: Total: 2.1 million (1.9-2.4 million)" (2007). Tracing the trends of the HIV/AIDS epidemic it is obvious that new research, new approach, new tools, new technology and new efforts are needed worldwide (ICAD-CISD, 2008). The position about the pandemic is approached by the UNAIDS as follows: "We know with increasing certainty what disaster awaits if the response to AIDS continues to be inadequate. We also know how to strengthen that response in ways that will save millions of lives and billions of dollars. This plan is achievable, but only with strong leadership at every level of society. We know what needs to be done to stop AIDS. What we need now is the will to get it done." According to the Watch Tower Society, it is necessary to face the pandemic from a spiritual point of view. In the Lord's Prayer or Our Father, the will of God is invoked so the Watch Tower Society remarks the following about it: "It is not God's will for humans to be forever plagued with illness. God will answer that prayer. In doing so, he will bring an end not only to AIDS but to all other diseases that plague humankind. Then, "no resident will say: 'I am sick.'" -Isaiah 33:24." (1998). The HIV/AIDS pandemic must to fought with energetic measuress, but it is necessary to understand that ultimately there won't be any disease affecting Humankind thanks to the Creator's intervention for the benefit of Humankind. References Avert.Org. (2008, Feb. 7). HIV & AIDS in Brazil. Retrieved March 26, 2008, from http://www.avert.org/aids-brazil.htm Bate, R., & Tren, R. (2005, Dec. 12). Brazil's AIDS Program: A Costly Success. Health Policy Outlook. Print Index No. 19367. American Enterprise Institute for Public Policy Research (AEI). Retrieved March 25, 2008, from http://www.aei.org/publications/pubID.23576/pub_detail.asp Brazilian Ministry of Health. (2008, Feb. 8). Brazil Response: 2005-2007: Country Progress Report. Joint United Nations Programme on HIV/AIDS (UNAIDS). Brazilian Ministry of Health. Health Surveillance Secretariat. National Programme STD and AIDS. Retrieved March 26, 2008, from http://data.unaids.org/pub/Report/2008/brazil_2008_country_progress_report_en.pdf Camargo, K. (2005, October). National Programme History. Adapted by Dr. P. Chequer, Director of the Brazilian National STD/AIDS Programme. Ministrio de Sade, Brazil. Retrieved March 25, 2008, from http://www.aids.gov.br/data/Pages/LUMISBD1B398DITEMID0FE488C7CE8E4EB1A09326528B487409ENIE.htm Colitt, R. (2007, Nov. 21). Brazil Moving Closer to Curbing AIDS - Officials. Reuters, Brasilia, Brazil. Retrieved March 26, 2008, from http://www.reuters.com/article/americasCrisis/idUSN21175233 Duffy, G. (2007, Nov. 14). Brazil's Aids Policy "Remarkable". BBC News, Sao Paulo, Brazil. Retrieved March 26, 2008, from http://news.bbc.co.uk/2/hi/americas/7093809.stm Gewertz, K. (2007, Mar. 27). Battling AIDS in Brazil: A Message of Hope. In Harvard University Gazette. Retrieved March 26, 2008, from http://harvardscience.harvard.edu/medicine-health/articles/battling-aids-brazil-message-hope IAS. (2005). FACT SHEET: HIV/AIDS in Brazil and Latin America. Third IAS Conference on HIV Patognesis and Treatment. International AIDS Society (IAS). Retrieved March 26, 2008, from http://www.ias-2005.org/admin/images/upload/534.pdf ICAD-CISD. (2008, January). Tools, Trends and New Technology in HIV Prevention. Interagency Coalition on AIDS and Development - Coalition Interagence SIDA et Dveloppement (ICAD-CISD). Ontario, Canada. Retrieved March 26, 2008, from http://www.icad-cisd.com/pdf/publications/New_Technologies_in_HIV_Prevention_FINAL_EN.pdf Mantesso, A. (2006, Nov. 30). HIV/AIDS in Brazil. UNESCO-L'OREAL For Women in Science Fellow. Retrieved March 26, 2008, from http://www.agora.forwomeninscience.com/the_fight_against_aids/2006/11/hivaids_in_brazil.php National STD and AIDS Programme. (2008, Feb. 14). UNGASS Report 2005-2007. Retrieved March 25, 2008, from http://www.aids.gov.br/data/Pages/LUMISE77B47C8ITEMID4078694D3C624E898C8CA08EAA6D76EBENIE.htm Okie, S. (M.D.). (2006, May 11). Lessons from Brazil. The New England Journal of Medicine (NEJM). Massachusetts Medical Society. Retrieved March 26, 2008, from http://content.nejm.org/cgi/content/full/354/19/1977 The Economist. (2008, Mar. 13). AIDS in Brazil: A Portrait in Red. Retrieved March 25, 2008, from http://www.economist.com/world/la/displaystory.cfmstory_id=10854276 UNAIDS. (2006, May). 2006 Report on the Global AIDS Epidemic. Joint United Nations Programme on HIV/AIDS (UNAIDS). Retrieved March 25, 2008, from http://www.unaids.org/en/KnowledgeCentre/HIVData/GlobalReport/ UNAIDS. (2007). Brazil. Joint United Nations Programme on HIV/AIDS (UNAIDS). Retrieved March 25, 2008, from http://www.unaids.org/en/CountryResponses/Countries/brazil.asp UNAIDS. (2007, Nov. 19). 2007 AIDS Epidemic Update. Joint United Nations Programme on HIV/AIDS (UNAIDS). Retrieved March 26, 2008, from http://www.unaids.org/en/KnowledgeCentre/HIVData/EpiUpdate/EpiUpdArchive/2007/ UNAIDS. (2008, Feb. 8). Brazil: 2008 Country Progress Report. Joint United Nations Programme on HIV/AIDS (UNAIDS). Retrieved March 26, 2008, from http://data.unaids.org/pub/Report/2008/brazil_2008_country_progress_report_en.pdf USAID. (2004, February). HIV/AIDS Country Profile: Brazil. U.S. Agency for International Development (USAID). Bureau for Global Health. Retrieved March 26, 2008, from http://www.usaid.gov/our_work/global_health/aids/Countries/lac/brazilbrief.pdf Watch Tower Society. (1998, Nov. 8). The Battle Against AIDS-Will It Be Won AIDS: What Hope For the Future In Awake! Watch Tower Bible and Tract Society of Pennsylvania. Retrieved March 25, 2008, from http://www.watchtower.org/e/19981108/article_03.htm Read More